Mucinous cystic neoplasms of the mesentery: a case report and review of the literature

  • Georgios Metaxas1Email author,

    Affiliated with

    • Athanasios Tangalos2,

      Affiliated with

      • Polyxeni Pappa2 and

        Affiliated with

        • Irene Papageorgiou3

          Affiliated with

          World Journal of Surgical Oncology20097:47

          DOI: 10.1186/1477-7819-7-47

          Received: 21 January 2009

          Accepted: 19 May 2009

          Published: 19 May 2009



          Mucinous cystic neoplasms arise in the ovary and various extra-ovarian sites. While their pathogenesis remains conjectural, their similarities suggest a common pathway of development. There have been rare reports involving the mesentery as a primary tumour site.

          Case presentation

          A cystic mass of uncertain origin was demonstrated radiologically in a 22 year old female with chronic abdominal pain. At laparotomy, the mass was fixed within the colonic mesentery. Histology demonstrated a benign mucinous cystadenoma.

          Methods and results

          We review the literature on mucinous cystic neoplasms of the mesentery and report on the pathogenesis, biologic behavior, diagnosis and treatment of similar extra-ovarian tumors. We propose an updated classification of mesenteric cysts and cystic tumors.


          Mucinous cystic neoplasms of the mesentery present almost exclusively in women and must be considered in the differential diagnosis of mesenteric tumors. Only full histological examination of a mucinous cystic neoplasm can exclude a borderline or malignant component. An updated classification of mesenteric cysts and cystic tumors is proposed.


          Cysts of the mesentery, retroperitoneum and omentum present with similar incidence in both sexes, varying between 1:260,000 and 1:27,000 in adults and 1:20,000 in children. They are usually incidental, or present with unspecific and chronic symptoms involving abdominal pain, distention, a palpable mass, gastrointestinal and urinary obstruction [13]. Acute manifestation is more often described in children and infants and may be associated with rupture [48], hemorrhage [9], torsion [10], infection or complicated hernia [11]. A 3% malignancy rate has been demonstrated [1].

          Mucinous cystic neoplasms

          Mucinous cystic neoplasms (MCNs) arise in the ovary and various extra-ovarian sites, predominantly but not exclusively [1, 1216] in adult females. The similarities between ovarian [17] and extra-ovarian MCNs suggest a common pathway of development. The cyst wall of extra-ovarian MCNs [18] is lined by mucin-secreting flat, cuboidal and/or columnar epithelium associated with an underlying subepithelial ovarian like stroma (OLS). OLS is documented by histological features (spindle shaped cells and myofibroblastic proliferation on electron microscope study) and immunohistochemistry (positivity for vimentin, α-smooth muscle actin and desmin) [1922]. Although the presence of OLS is considered a requisite diagnostic criterion for MCNs, this is not always identified. MCNs have been extensively described in the pancreas [1827], the appendix [2830] and the hepatobiliary tract [31, 32] and more rarely in the retroperitoneum [3335] paratesticular tissues [3641], lung [4244]breast [4547], spleen [18, 48, 49] bowel [50] and the mesentery.

          Case presentation

          A 22 year old white-Caucasian female, with otherwise unremarkable history, presented with chronic, left sided, vague abdominal pain. There were no abnormal findings on clinical examination. Ultrasound (US), computerized tomography (CT) and magnetic resonance (MR) scans (Fig. 1a, b) demonstrated a unilocular cystic mass measuring 8.5 × 6 × 3.5 cm and lying medially to the descending colon. No definite preoperative diagnosis could be established. At laparotomy the mass was fixed within the descending and sigmoid colonic mesentery (Fig. 2). As there were no firm adhesions or shared blood supply (Fig. 3), enucleation was easily performed. The cyst had a macroscopically thin and smooth wall and contained white-yellowish fluid. The cyst wall was examined in its entirety. Histology demonstrated two distinct components: an outer ovarian-like stromal layer, composed of densely packed spindle-shaped cells (Fig. 4) and an inner epithelial layer, consisting of cuboidal and columnar mucinous cells (Fig. 5, 6). Immunohistochemical study of the stromal cells demonstrated positivity for vimentin, actin, and desmin. The epithelial cells showed positivity for cytokeratin-7 (Fig. 6), CA-125 (Fig. 7), CEA, and CA 19-9 and negative expression of cytokeratin-20. There was no cellular atypia. The overall features suggested a benign neoplasm of epithelial origin with the appearance of an ovarian mucinous cystadenoma. The patient recovered uneventfully and remained well on annual follow-up with abdominal US.

          Figure 1

          (a, b): MR scan appearance of the cystic tumour (arrow).

          Figure 2

          Intra-operative appearance, medial view of the mesentery, inferion mesenteric vessels lying on the cyst surface.

          Figure 3

          Lateral view of mesentery, cyst enucleation in an avascular plane.

          Figure 4

          Microscopic appearance of the cyst wall, ovarian like stroma, epithelial lining.

          Figure 5

          Benign columnar mucinous epithelium lining of the cyst wall. Immunohistochemistry reveals stromal positivity for actin.

          Figure 6

          Immunohistochemistry, epithelial positivity for CK 7.

          Figure 7

          Immunohistochemistry, epithelial positivity for CA-125.


          There are thirteen documented cases of mesenteric MCNs in the literature prior to this report (Table 1). Five of those originated from the mesentery of the small intestine [15, 18, 5153], one from the mesoappendix [54] and seven from the mesocolon [5560]. The only male patient was a five year old child with an unresectable neoplasm [15]. Clinical presentation typically involved chronic abdominal pain (n = 8) and distention (n = 5). Three patients were asymptomatic and one presented with acute manifestation of symptoms. Interestingly, preoperative imaging was inconclusive in nine cases, suggested ovarian origin in four cases, and mesenteric origin in only one case. No pathognomonic malignant features were illustrated. Pathology reported nine benign mucinous cystadenomas (including the present case), three borderline MCNs, (based on the presence of atypical nuclei, pseudo-stratification, glandular arrangements and lack of invasion) and two carcinomas. The median age at diagnosis of benign mesenteric MCNs was 26.1 yrs, compared to 35.2 yrs for non-benign tumours. One of the carcinomas [51] was thought to be the result of malignant transformation following earlier incomplete excisions of a recurrent benign tumour. One of the patients with a borderline tumour, presented with metastatic disease in the mediastinal lymph nodes four years after removal, which may represent a missed invasive focus due to incomplete examination of the entire neoplasm wall. This patient had initially undergone a partial colectomy and salpingo-oophoretomy [55]. Another two patients underwent partial colectomies due to cyst wall adhesions, while enucleation of the tumor was performed in six. Partial cystectomy was performed in two unresectable tumors. Immunohistochemistry was reported in four cases. There was no report of ectopic ovarian tissue or evidence of teratomatous developement. There was no association between the age and tumor size.
          Table 1

          Reported cases of mesenteric mucinous cystic neoplasms of the large intestine (1–8), small intestine (9–13) and appendix (14). *No details contained in published article.



          Age Sex

          Clinical presentation

          Imaging tests - correlated diagnosis

          Size (cm)



          Histology - Immunohistochemistry


          Banerjee et al. (1988) [55]

          58 F

          Incidental finding

          US, Uncertain


          Hepatic flexure

          Right Hemicoletomy

          Benign mucinous cystadenoma



          38 F

          Pain, distention

          US, Uncertain


          Descending colon

          Colectomy Salpingo-oophorectomy

          Borderline malignant MCN


          McEvoy et al. (1997) [56]

          24 F

          Pain, constipation distension.

          US, Ovarian origin

          20 × 15

          Sigmoid colon.


          Benign mucinous cystadenoma (CAM 5.2, CEA)+, Factor VIII -


          Linden et al. (2000) [58]

          32 F

          Incidental finding

          US, CT, Uncertain

          13 × 10 × 10

          Transverse colon


          Mucinous cystadenocarcinoma


          Vrettos et al. (2000) [59]

          38 F

          Pain, nausea, vomiting, distention, oedema of the lower limbs

          US, CT Mesenteric cyst

          17 × 12

          Sigmoid colon.


          Borderline malignant MCN


          Talwar et al. (2004) [57]

          32 F

          Acute pain, vomiting, urinary frequency, constipation

          US, Ovarian origin

          10 × 7 × 5

          Descending colon

          Left hemicolectomy

          Borderline malignant MCN


          Swaveling et al. (2008) [60]

          18 F

          Asymptomatic abdominal swelling

          US, CT, Uncertain Adjacent to R kidney


          Right hemicolon


          Benign mucinous cystadenoma


          Present case

          22 F


          US, CT, MRI, Uncertain

          8.5 × 6 × 3.5

          Descending + sigmoid colon


          Benign mucinous cystadenoma (CK7, CEA, CA19-9, CA125, actin, desmin, vimentin)+, ck20(-),


          Cohen et al (1988) [52]

          36 F

          Found during pregncy




          Cyst resection

          Benign mucinous cystadenoma


          Bury and Pricolo (1994) [51]

          36 F

          Pain, reccurent unresectable cysts én a 13 year period,



          Small intestine Unspecified

          Partial cyst resections

          Incomplete excision, transformation to carcinoma CK+, EMA, CEA, B72.3, Leu M1


          Czubalski et al. (2004) [53]

          38 F


          Ovarian origin




          Benign mucinous cystadenoma


          Shioho et al (2006) [18]

          14 F






          Benign mucinous cystadenoma


          Luo et al (2008) [15]

          5 M

          Abdominal pain and swelling



          Small intestine Unspecified

          Unresectable, Segmental excision

          Benign mucinous cystadenoma, (biopsy only) ER, PR (-), Inhibin (+), OLS +


          Felemban & Tulandi (2000) [54]

          20 F

          Abdominal pain, back ache

          US, Ovarian origin

          7.6 × 7 × 5.3


          Lap. Enucleation, appendicectomy

          Benign mucinous cystadenoma

          Pathogenesis and biologic behavior of extra-ovarian MCNs

          The origin of extra-ovarian MCNs has been sporadically attributed to implanted or ectopic ovarian tissue [61], supernumerary ovaries [62, 63] or mono-phyletic developement of a teratoma component [6466]. A recent concept linked the development of hepatic and pancreatic MCNs to the migration of epithelial cells from the embryonic gonads during early foetal life [67]. The most widely accepted theories for the pathogenesis of extra-ovarian MCNs include: Coelomic metaplasia of epithelial cells or invaginated peritoneum along the course of ovarian descent, mucinous metaplasia in pre-existing mesothelial cysts and neoplastic differentiation of epithelial cells from a secondary extragenital Mullerian system [1, 2, 51, 6871].

          According to the WHO classification (ICD 10), MCNs are divided into benign adenomas, borderline tumours, non-invasive (in situ) and invasive carcinomas. The malignant potential of all MCNs is supported by observations of malignant transformation of benign neoplasms during long term follow up [24, 51]. Other authors noticed a frequent concurrence of benign and focally borderline or/and malignant epithelium [21, 72, 73]. Also, as illustrated in the present study and previous pancreatic MCNs series [72, 74], the median age at diagnosis is higher for malignant MCNs, which implies progression from adenoma to carcinoma. Consequently, failure to excise or study the entire cyst wall may result in the miscategorization of a neoplasm [75].

          When differentiating mucinous from non mucinous neoplasms and non neoplastic cysts and evaluating their malignant potential, the following features may have a positive predictive but not pathognomonic value: Patient age and tumour size [27, 74], multilocularity, presence of calcifications [58], intracystic papillary projections or mural nodules [20], presence or lack of OLS [20, 76], nuclei atypia, co-expression of (a6)-integrin and p53 immunoactivity [20, 77], high viscosity and/or high levels of CEA in the cyst fluid and positivity of other tumours markers (Ca 19-9, Ca-125, Ca 15-3) [24, 78, 79]. Oestrogen and progesterone receptor positivity in stromal cells varies [80].

          Classification of mesenteric cysts and cystic tumors

          None of the recognized classifications of mesenteric cysts [8185], has included MCNs up to date. Malignant mesothelioma is suggested as the only potential primary cystic malignancy in the mesentery. We found three more cases of primary mesenteric cystic neoplasms in the literature [8688], as well as reports of mesenteric hydatid [8, 8992]] and tuberculous cysts [9395]. In view of the existing data, we propose an updated classification of mesenteric cysts and cystic tumors, as shown in the Appendix.

          Diagnosis and treatment

          There is no definitive diagnostic test. Radiological examinations may suggest the origin of a cyst, but cannot exclude the malignant potential of an MCN [35, 82, 84, 9699]. Guided aspiration cytology and fluid analysis is rarely diagnostic, has a high false negative incidence [100] and may only be helpful in the complicated management of pancreatic cystic masses [101, 102]. The definite diagnosis remains postoperative and therefore intra-operative frozen section does not have any use. Following exclusion of non-surgical conditions, complete excision is the only treatment option for all mesenteric neoplasms [103105] because of their malignant potential as well as the high recurrence rate of benign tumors - such as lymphangiomas and mesotheliomas - after incomplete resection [106108]. Open or laparoscopic approach depends on the surgeon's skills, as more complicated resections may be required [109111]. Only one mesenteric MCN has been treated laparoscopically up to date, by a gynaecologist [54].


          Mucinous cystic neoplasms of the mesentery present almost exclusively in women and must be considered in the differential diagnosis of mesenteric tumors. Whilst there are no pathognomonic diagnostic criteria, a mesenteric cyst should be approached as potentially malignant especially in adults. Only complete excision and full histological examination of a mucinous cystic neoplasm can exclude a borderline or malignant component. We propose an updated classification of mesenteric cysts.


          Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal


          Proposed updated classification of mesenteric cysts and cystic tumors

          Mesenteric Cysts and Cystic Tumors

          Cysts of lymphatic origin

          • Simple lymphatic cyst

          • Lymphangioma

          Cysts of mesothelial origin

          • Simple mesothelial cyst

          • Benign cystic mesothelioma

          • Malignant cystic mesothelioma

          Cysts of enteric origin

          • Enteric duplication cyst

          • Enteric cyst

          Mucinous cystic neoplasms

          • Mucinous cystadenoma

          • Borderline malignant mucinous cystic neoplasm

          • Mucinous cystadenocarcinoma

          Cysts of urogenital origin

          Miscellaneous neoplasms

          • Mature cystic teratoma

          • Neuroendocrine carcinoma

          • Cystic spindle cell tumor

          Non - neoplastic cysts

          • Hydatid cyst

          • Tuberculous cyst

          Non - pancreatic pseudocysts

          • Haematoma

          • Abscess



          Authors wish to thank Ms Cliona Kirwan, Lecturer in Surgical Oncology at the University of Manchester, for her assistance in editing the article.

          Authors’ Affiliations

          The Nightingale and Genesis Prevention Centre, University Hospital of South Manchester
          2nd Department of Surgery, Helena Venizelos General Hospital
          Department of Surgery, Drama General Hospital


          1. Kurtz R, Heimann T, Beck R, et al.: Mesenteric and retroperitoneal cysts. Ann Surg 1986, 109–112.
          2. Vanek VW, Phillips AK: Retroperitoneal, mesenteric and omental cysts. Arch Surg 1984, 119:838–42.PubMed
          3. Liew SC, Glenn DC, Storey DW: Mesenteric cyst. ANZ J Surg 1994, 64:741–744.View Article
          4. Pisano G, Erdas E, Parodo G, et al.: Acute abdomen due to rupture of mesenteric cysts. Observations on a clinical case and review of the literature. Minerva Chir. 2004,59(4):405–411.PubMed
          5. Ekçi B, Ayan F, Gürses B: Ruptured mesenteric cyst: a rare presentation after trauma. Ulus Travma Acil Cerrahi Derg 2007,13(1):74–7.PubMed
          6. Vlazakis SS, Gardikis S, Sanidas E, et al.: Rupture of mesenteric cyst after blunt abdominal trauma. Eur J Surg 2000,166(3):262–4.PubMedView Article
          7. Takeuchi K, Takaya Y, Maeda K, et al.: Peritonitis caused by a ruptured, infected mesenteric cyst initially interpreted as an ovarian cyst. A case report. J Reprod Med 2004,49(1):65–7.PubMed
          8. Kusaslan R, Sahin DA, Belli AK, et al.: Rupture of a mesenteric hydatid cyst: a rare cause of acute abdomen. Can J Surg 2007,50(5):E3–4.PubMed
          9. Okamoto D, Ishigami K, Yoshimitsu K, et al.: Hemorrhagic mesenteric cystic lymphangioma presenting withacute lower abdominal pain: the diagnostic clues on MR Imaging. Emerg Radiol 2008.
          10. Addison NV: Torsion of a mesenteric lymphatic cyst. Br Med J 1953,1(4823):1316.PubMedView Article
          11. Polat C, Tokyol C, Dilek ON: Strangulated umbilical hernia including a mesenteric cyst: a rare cause of acute abdomen. Acta Chir Belg 2003,103(3):329–31.PubMed
          12. Green JM, Bruner BC, Tang WW, et al.: Retroperitoneal mucinous cystadenocarcinoma in a man: case report and review of the literature. Urol Oncol 2007,25(1):53–5.PubMedView Article
          13. Thamboo TP, Sim R, Tan SY, et al.: Primary retroperitoneal mucinous cystadenocarcinoma in a male patient. Clin Pathol 2006,59(6):655–7.View Article
          14. Saw EC, Ramachandra S: Laparoscopic resection of a giant mesenteric cyst. Surg Laparosc Endosc 1994,4(1):59–61.PubMed
          15. Luo JJ, Baksh FK, Pfeifer JD, et al.: Abdominal mucinous cystic neoplasm in a a male child. Pediatr Dev Pathol 2008,11(1):46–9.PubMedView Article
          16. Prabhuraj AR, Basu A, Sistla SC, et al.: Primary retroperitoneal mucinous cystadenoma in a man. Am J Clin Oncol 2008,31(5):519–20.PubMedView Article
          17. Hart WR: Mucinous tumors of the ovary: a review. Int J Gynecol Pathol 2005,24(1):4–25.PubMed
          18. Shiono S, Suda K, Nobukawa B, et al.: Pancreatic, hepatic, splenic, and mesenteric mucinous cystic neoplasms (MCN) are lumped together as extraovarian MCN. Pathology International 2006, 56:71–77.PubMedView Article
          19. Izumo A, Yamaguchi K, Eguchi T, et al.: Mucinous cystic tumor of the pancreas: immunohistochemical assessment of "ovarian type stroma.". Oncol Rep 2003, 10:515–525.PubMed
          20. Zamboni G, Scarpa A, Bogina G, et al.: Mucinous cystic tumors of the pancreas: clinicopathological features, prognosis, and relationship to other mucinous cystic tumors. Am J Surg Pathol 1999, 23:410–422.PubMedView Article
          21. Thompson LD, Becker RC, Przygodzki RM, et al.: Mucinous cystic neoplasm (mucinous cystadenocarcinoma of low grade malignant potential) of the pancreas: a clinicopathologic study of 130 cases. Am J Surg Pathol 1999, 23:1–16.PubMedView Article
          22. Fukushima N, Mukai K: 'Ovarian-type' stroma of pancreatic mucinous cystic tumor expresses smooth muscle phenotype. Pathol Int 1997, 47:806–808.PubMedView Article
          23. Adsay NV: Cystic neoplasia of the pancreas: pathology and biology. J Gastrointest Surg 2008,12(3):401–4.PubMedView Article
          24. Kloppel G, Solcia E, Longnecker DS, et al.: Histological typing of tumors of the exocrine pancreas. 2 Edition Berlin: Springer 1996.
          25. Le Borgne J, De Calan L, Partensky C: Cystadenomas and Cystadenocarcinomas of the Pancreas. A Multiinstitutional Retrospective Study of 398 Cases. Ann Surg 1999,230(2):152–61.PubMedView Article
          26. Goh BK, Tan YM, Chung YF, et al.: A review of mucinous cystic neoplasms of the pancreas defined by ovarian-type stroma: clinicopathological features of 344 patients. World J Surg 2006,30(12):2236–45.PubMedView Article
          27. Reddy RP, Smyrk TC, Zapiach M, et al.: Pancreatic mucinous cystic neoplasm defined by ovarian stroma: demographics, clinical features, and prevalence of cancer. Clin Gastroenterol Hepatol 2004,2(11):1026–31.PubMedView Article
          28. Smeenk RM, Van Velthuysen MLF, Verwaal VJ, et al.: Appendiceal neoplasms and pseudomyxoma peritonei: A population based study. Eur J Surg Oncol. 2008,34(2):196–201.PubMed
          29. Ruiz-Tovar J, Garcýa Teruel D, Morales Castineiras V, et al.: Mucocele of the Appendix. World J Surg 2007, 31:542–548.PubMedView Article
          30. Karakaya K, Barut F, Emre AU, et al.: Appendiceal mucocele: case reports and review of current literature. World J Gastroenterol 2008,14(4):2280–3.PubMedView Article
          31. Devaney K, Goodman ZD, Ishak KG: Hepatobiliary cystadenoma and cystadenocarcinoma. A light microscopic and immunohistochemical study of 70 patients. Am J Surg Pathol 1994,18(11):1078–91.PubMedView Article
          32. Vogt DP, Henderson JM, Chmielewski E: Cystadenoma and cystadenocarcinoma of the liver: a single center experience. J Am Coll Surg 2005,200(5):727–33.PubMedView Article
          33. Bifulco G, Mandato VD, Giampaolino P, et al.: Huge primary retroperitoneal mucinous cystadenoma of borderline malignancy mimicking an ovarian mass: case report and review. Anticancer Res 2008,28(4C):2309–15.PubMed
          34. Yan SL, Lin H, Kuo CL, et al.: Primary retroperitoneal mucinous cystadenoma: Report of a case and review of the literature. World J Gastroenterol 2008,14(37):5769–72.PubMedView Article
          35. Yang DM, Jung DH, Kim H, et al.: Retroperitoneal cystic masses: CT, clinical, and pathologic findings and literature review. Radiographics 2004,24(5):1353–65.PubMedView Article
          36. Ulbright TM, Young RH: Primary mucinous tumors of the testis and paratestis: a report of nine cases. Am J Surg Pathol 2003,27(9):1221–8.PubMedView Article
          37. Uschuplich V, Hilsenbeck JR, Velasco CR: Paratesticular mucinous cystadenoma arising from an oviduct-like müllerian remnant: a case report and review of the literature. Arch Pathol Lab Med 2006,130(11):1715–7.PubMed
          38. Rizzardi C, Brollo A, Thomann B, et al.: Intra-abdominal ovarian-type mucinous cystadenoma associated with fallopian tube-like structure and aberrant epididymal tissue in a male patient. Hum Pathol 2005,36(8):927–31.PubMedView Article
          39. Shimbo M, Araki K, Kaibuchi T, et al.: Mucinous cystadenoma of the testis. J Urol 2004,172(1):146–7.PubMedView Article
          40. Naito S, Yamazumi K, Yakata Y, et al.: Immunohistochemical examination of mucinous cystadenoma of the testis. Pathol Int 2004,54(5):355–9.PubMedView Article
          41. Nokubi M, Kawai T, Mitsu S, et al.: Mucinous cystadenoma of the testis. Pathol Int 2002,52(10):648–52.PubMedView Article
          42. Ishibashi H, Moriya T, Matsuda Y, et al.: Pulmonary mucinous cystadenocarcinoma: report of a case and review of the literature. Ann Thorac Surg 2003,76(5):1738–40.PubMedView Article
          43. Gao ZH, Urbanski SJ: The spectrum of pulmonary mucinous cystic neoplasia: a clinicopathologic and immunohistochemical study of ten cases and review of literature. Am J Clin Pathol 2005,124(1):62–70.PubMedView Article
          44. Wynveen C, Behmaram B, Haasler G, et al.: Diverse histologic appearances in pulmonary mucinous cystic neoplasia: A case report. J Med Case Reports. 2008,29(2):312.View Article
          45. Koenig C, Tavassoli FA: Mucinous cystadenocarcinoma of the breast. Am J Surg Pathol 1998,22(6):698–703.PubMedView Article
          46. Chen WY, Chen CS, Chen HC, et al.: Mucinous cystadenocarcinoma of the breast coexisting with infiltrating ductal carcinoma. Pathol Int 2004,54(10):781–6.PubMedView Article
          47. Lee SH, Chaung CR: Mucinous metaplasia of breast carcinoma with macrocystic transformation resembling ovarian mucinous cystadenocarcinoma in a case of synchronous bilateral infiltrating ductal carcinoma. Pathol Int 2008,58(9):601–5.PubMedView Article
          48. Morinaga S, Ohyama R, Koizumi J: Low-grade mucinous cystadenocarcinoma in the spleen. Am J Surg Pathol 1992,16(9):903–8.PubMedView Article
          49. Hirota M, Hayashi N, Tomioka T, et al.: Mucinous cystadenocarcinoma of the spleen presenting a point mutation of the Kirsten-ras oncogene at codon 12. Dig Dis Sci 1999,44(4):768–74.PubMedView Article
          50. Shaco-Levy R, Tsodikov V, Levy I: Mucinous cystadenoma of the ascending colon: a novel presentation. Scand J Gastroenterol 2003,38(11):1193–5.PubMedView Article
          51. Bury TF, Pricolo VE: Malignant transformation of benign mesenteric cyst. Am J Gastroenterol 1994,89(11):2085–7.PubMed
          52. Cohen I, Altaras M, Lew S, et al.: Huge mesenteric mucinous cystadenoma in normal pregnancy. Obstet Gynecol 1988, 71:1030–2.PubMed
          53. Czubalski A, Barwijuk A, Radiukiewicz G: Large mesenteric cyst in a patient suspected of ovarian cyst. Ginekol Pol 2004,75(7):545–7.PubMed
          54. Felemban A, Tulandi T: Laparoscopic excision of a mesenteric cyst diagnosed preoperatively as an ovarian cyst. J Am Assoc Gynecol Laparosc 2000,7(3):429–31.PubMedView Article
          55. Banerjee R, Gough J: Cystic mucinous tumours of the mesentery and retro-peritoneum: report of three cases. Histopathology 1988, 12:527–32.PubMedView Article
          56. McEvoy AW, Cahill CJ, Jameson C: Mucinous cystadenoma of the sigmoid colon: a previously unreported abdominal tumour. Eur J Surg Oncol 1997, 23:88–90.PubMedView Article
          57. Talwar a, Bell NJ, Nicholas D: Mucinous cystadenoma of colonic mesentery: Report of a case. Dis Colon Rectum 2004, 47:1412–1414.PubMedView Article
          58. Linden PA, Ashley SW: Mucinous cystadenocarcinoma of the mesentery. Surgery 2000,127(6):707–8.PubMedView Article
          59. Vrettos ME, Kostopoulou E, Papavasileiou C, et al.: A mucinous tumour of the mesocolon with features of borderline malignancy. Surg Endosc 2000,14(6):595.PubMed
          60. Zwaveling S, den Outer AJ, da Costa SA: A mucinous cystadenoma in the mesentery of the right hemicolon. Acta Chir Belg 2008,108(3):354–5.PubMed
          61. Payan HM, Gilbert EF: Mesenteric cyst-ovarian implant syndrome. Arch Pathol Lab Med 1987,111(3):282–4.PubMed
          62. Storch MP, Raghavan U: Mucinous cystadenocarcinoma of retroperitoneum. Conn Med 1980, 44:140–1.PubMed
          63. Lapertosa G: Histogenetic considerations on mucinous cystomas of the ovary based on histochemical and immunohistochemical findings. Pathologica 1989, 81:381–401.PubMed
          64. McKenney JK, Soslow RA, Longacre TA: Ovarian mature teratomas with mucinous epithelial neoplasms: morphologic heterogeneity and association with pseudomyxoma peritonei. Am J Surg Pathol 2008,32(5):645–55.PubMedView Article
          65. Moid FY, Jones RV: Granulosa cell tumor and mucinous cystadenoma arising in a mature cystic teratoma of the ovary: A unique case report and review of literature. Ann Diagn Pathol 2004,8(2):96–101.PubMedView Article
          66. Tang P, Soukkary S, Kahn E: Mature cystic teratoma of the ovary associated with complete colonic wall and mucinous cystadenoma. Ann Clin Lab Sci 2003,33(4):465–70.PubMed
          67. Erdogan D, Lamers WH, Offerhaus GJ, et al.: Cystadenomas with ovarian stroma in liver and pancreas: an evolving concept. Dig Surg 2006,23(3):186–91.PubMedView Article
          68. Lauchlan SC: The secondary Mullerian system. Obstet Gynaecol Surv 1972, 27:133.View Article
          69. Lauchlan SC: The secondary müllerian system revisited. Int J Gynecol Pathol 1994,13(1):73–9.PubMedView Article
          70. Fujii S, Konishi I, Okamura H, Mori T: Mucinous cystadenocarcinoma of the retroperitoneum: a light and electron microscopic study. Gynecol Oncol 1986, 24:103–12.PubMedView Article
          71. Tykkä H, Koivuniemi A: Carcinoma arising in a mesenteric cyst. Am J Surg 1975,129(6):709–11.PubMedView Article
          72. Compagno J, Oertel JE: Mucinous cystic neoplasms of the pancreas with overt and latent malignancy (cystadenocarcinoma and cystadenoma). A clinicopathologic study of 41 cases. Am J Clin Pathol 1978, 69:573–80.PubMed
          73. Roth LM, Ehrlich CE: Mucinous cystadenocarcinoma of the retroperitoneum. Obstet Gynecol 1977,49(4):486–8.PubMed
          74. Crippa S, Salvia R, Warshaw AL, Domínguez I, et al.: Mucinous cystic neoplasm of the pancreas is not an aggressive entity: lessons from 163 resected patients. Ann Surg 2008,247(4):571–9.PubMedView Article
          75. Wilentz RE, Albores-Saavedra J, Zahurak M, et al.: Pathologic examination accurately predicts prognosis in mucinous cystic neoplasms of the pancreas. Am J Surg Pathol 1999,23(11):1320–7.PubMedView Article
          76. Shimizu Y, Yasui K, Yamao K, et al.: Possible oncogenesis of mucinous cystic tumors of the pancreas lacking ovarian-like stroma. Pancreatology 2002,2(4):413–20.PubMedView Article
          77. Sawai H, Okada Y, Funahashi H, et al.: Clinicopathological and immunohistochemical analysis of malignant features in mucinous cystic tumors of the pancreas. Hepatogastroenterology 2006,53(68):286–90.PubMed
          78. Jeurnink SM, Vleggaar FP, Siersema PD: Overview of the clinical problem: facts and current issues of mucinous cystic neoplasms of the pancreas. Dig Liver Dis 2008,40(11):837–46.PubMedView Article
          79. Bassi C, Salvia R, Gumbs AA, et al.: The value of standard serum tumor markers in differentiating mucinous from serous cystic tumors of the pancreas: CEA, Ca 19–9, Ca 125, Ca 15–3. Langenbecks Arch Surg 2002, 387:281–5.PubMedView Article
          80. Murakami Y, Uemura K, Morifuji M, et al.: Mucinous cystic neoplasm of the pancreas with ovarian-type stroma arising in the head of the pancreas: case report and review of the literature. Dig Dis Sci 2006,51(3):629–32.PubMedView Article
          81. Beahrs OH, Judd ES Jr, Dockerty MB: Chylous cysts of the abdomen. Surg Clin North Am 1950,30(4):1081–96.PubMed
          82. Ros PR, Olmsted WW, Moser RP Jr, et al.: Mesenteric and omental cysts: Histologic classification with imaging correlation. Radiology 1987, 164:327–332.PubMed
          83. de Perrot M, Bründler M, Tötsch M, et al.: Mesenteric cysts. Toward less confusion? Dig Surg 2000,17(4):323–8.PubMedView Article
          84. Sheth S, Horton KM, Garland MR, et al.: Mesenteric neoplasms: CT appearances of primary and secondary tumors and differential diagnosis. Radiographics 2003,23(2):457–73.PubMedView Article
          85. Mennemeyer R, Smith M: Multicystic, peritoneal mesothelioma, a report with electron microscopy of a case mimicking intra-abdominal cystic hygroma (lymphangioma). Cancer 1979, 44:692–698.PubMedView Article
          86. Punpale A, Shrikhande SV, Sumeet G, et al.: Primary neuroendocrine carcinoma presenting as mesenteric cyst. Indian J Gastroenterol 2007,26(3):137–8.PubMed
          87. Shitomi T, Akasaka I, Yamaguchi T, et al.: A case of mesenteric epithelioid leiomyosarcoma showing rapid growth of cystic component. Nippon Shokakibyo Gakkai Zasshi 2001,98(10):1179–84.PubMed
          88. McFadden DW, Hiyama D, Moulton JS, et al.: Primary mesenteric leiomyosarcoma masquerading as a pancreatic pseudocyst. Pancreas 1993,8(5):647–9.PubMedView Article
          89. Yildirim M, Erkan N, Vardar E: Hydatid cysts with unusual localizations: diagnostic and treatment dilemmas for surgeons. Ann Trop Med Parasitol 2006,100(2):137–42.PubMedView Article
          90. Cöl C, Cöl M, Lafçi H: Unusual localizations of hydatid disease. Acta Med Austriaca 2003,30(2):61–4.PubMedView Article
          91. Mavridis G, Livaditi E, Christopoulos-Geroulanos G: Management of hydatidosis in children. Twenty-one year experience. Eur J Pediatr Surg 2007,17(6):400–3.PubMedView Article
          92. Astarcioglu H, Koçdor MA, Topalak O, et al.: Isolated mesosigmoidal hydatid cyst as an unusual cause of colonic obstruction: report of a case. Surg Today 2001,31(10):920–2.PubMedView Article
          93. Emir H, Yesildag E, Sahin I, et al.: A case of mesenteric cysts caused by abdominal tuberculosis. Eur J Pediatr Surg 2000,10(6):402–3.PubMed
          94. Cheung HY, Siu WT, Yau KK, et al.: Acute abdomen: an unusual case of ruptured tuberculous mesenteric abscess. Surg Infect (Larchmt). 2005,6(2):259–261.View Article
          95. Borisa AD, Bakhshi GD, Tayade MB, et al.: A rare case of tuberculous mesenteric cyst masquerading as chylolymphatic mesenteric cyst. Bombay Hospital Journal 2008.,50(3):
          96. Nishino M, Hayakawa K, Minami M, et al.: Primary retroperitoneal neoplasms: CT and MR Imaging findings with anatomic and pathologic diagnostic clues. Radiographics 2003, 23:45–57.PubMedView Article
          97. Hamrick-Turner JE, Chiechi MV, Abbitt PL, et al.: Neoplastic and inflammatory processes of the peritoneum, omentum, and mesentery: diagnosis with CT. Radiographics 1992,12(6):1051–68.PubMed
          98. Stoupis C, Ros PR, Abbitt PL, et al.: Bubbles in the belly: imaging of cystic mesenteric or omental masses. Radiographics 1994,14(4):729–37.PubMed
          99. Ghossain MA, Braidy CG, Kanso HN, et al.: Extraovarian cystadenomas: ultrasound and MR findings in 7 cases. J Comput Assist Tomogr 2005,29(1):74–9.PubMedView Article
          100. Martínez-Onsurbe P, Ruiz Villaespesa A, Sanz Anquela JM, et al.: Aspiration cytology of 147 adnexal cysts with histologic correlation. Acta Cytol 2001,45(6):941–7.PubMed
          101. Attasaranya S, Pais S, LeBlanc J, et al.: Endoscopic ultrasound-guided fine needle aspiration and cyst fluid analysis for pancreatic cysts. JOP 2007,8(5):553–63.PubMed
          102. Linder JD, Geenen JE, Catalano MF: Cyst fluid analysis obtained by EUS-guided FNA in the evaluation of discrete cystic neoplasms of the pancreas: a prospective single-center experience. Gastrointest Endosc 2006,64(5):697–702.PubMedView Article
          103. Ammori BJ, Jenkins BL, Lim PC, et al.: Surgical strategy for cystic diseases of the liver in a western hepatobiliary center. World J Surg 2002, 26:462–469.PubMedView Article
          104. Kubota E, Katsumi K, Iida M, et al.: Biliary cystadenocarcinoma followed up as benign cystadenoma for 10 years. J Gastroenterol 2003, 38:278–282.PubMedView Article
          105. Horvath KD, Chabot JA: An aggressive resectional approach to cystic neoplasms of the pancreas. Am J Surg 1999, 178:269–274.PubMedView Article
          106. Walker AR, Putnam TC: Omental, mesenteric, and retroperitoneal cysts: a clinical study of 33 new cases. Ann Surg 1973,178(1):13–9.PubMedView Article
          107. Hebra A, Brown MF, McGeehin KM, et al.: Mesenteric, omental, and retroperitoneal cysts in children: a clinical study of 22 cases. South Med J 1993,86(2):173–6.PubMed
          108. Okur H, Küçükaydin M, Ozokutan BH, et al.: Mesenteric, omental, and retroperitoneal cysts in children. Eur J Surg 1997,163(9):673–7.PubMed
          109. Trompetas V, Varsamidakis N: Laparoscopic management of mesenteric cysts. Surg Endosc 2003,17(12):2036.PubMedView Article
          110. Morrison CP, Wemyss-Holden SA, Maddern GJ: A novel technique for the laparoscopic resection of mesenteric cysts. Surg Endosc 2002,16(1):219.PubMedView Article
          111. Shamiyeh A, Rieger R, Schrenk P, et al.: Role of laparoscopic surgery in treatment of mesenteric cysts. Surg Endosc 1999,13(9):937–9.PubMedView Article

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